Introduction
Faith-based organizations furnish medical and preventive health care
for millions of people around the globe. In almost all industrialized countries,
many of the best hospitals, clinics, and health programs were started by
communities of faith, and faith-based organizations continue to play major
roles in the founding of health initiatives. In some developing countries,
more than half of all medical care is provided by hospitals, clinics, and
pharmacies operated by faith-based organizations. If secular health development
agencies working in these poorer countries fail to recognize and partner
with these extensive systems of highly skilled and motivated health professionals,
the common goal of “Health for All” will not be attained. At a time when
the world requires partnerships in addressing growing global medical needs,
we must call into collaboration these organizations that provide medical
care, particularly in the developing world. By collaborating with these
well-established and trusted medical systems, the implementation and success
of meeting the medical needs of the world can be realized.
To define, faith-based organizations are founded by individuals or institutions
that adhere to the values and tenets of a given religion. The most far-reaching
of these organizations engaged in health development are associated with
the major faiths of the modern world including Christianity (both Protestant
and Catholic), Islam, Judaism.
Magnitude of Faith-Based Organizations in Health
Health improvements and care for the sick and dying have been integral
activities of many religious faiths throughout history. Priests, rabbis,
imams, and other religious leaders have served as healers, ministering
to both the body and the soul. The imprint of the faith community on global
health systems is vast. In almost all industrialized countries, many of
the best hospitals, clinics, and health programs were started by communities
of faith. Today, these organizations continue to be the major vehicle for
health advocacy as well as service delivery, particularly in low-income
communities.
While the governments of less developed countries generally provide
the majority of health services, a large proportion is provided privately,
usually by NGOs, many of which are faith-based. Millions of people around
the world, then, have no access to modern medical care apart from what
is furnished through the activities of churches, mosques, and synagogues.
Faith-based organizations may also provide the only opportunities in these
communities for literacy, agricultural and husbandry support, water and
sanitation assistance, etc. Additionally, short-term emergency relief around
the world, whatever the cause, is often provided by faith-based organizations.
Every year millions of dollars and thousands of people are mobilized by
such organizations to respond to the needs of disenfranchised communities
in the developing world. The sheer bulk of faith-based organizations should
ensure their participation at the tables of health development planning
and policy-making.
Types of Faith-Based Organizations
Broadly, two types of faith-based organizations provide health services
in developing countries: indigenous and foreign. Indigenous faith organizations
are those that are managed by the people of the country in which they operate.
Such organizations may be as localized as an individual neighborhood congregation
or as far-reaching as the All Africa Council of Churches.
Foreign faith-based organizations generally have their constituent and
financial bases in wealthy industrialized countries. Their activities in
developing countries are both long- and short-term and are carried out
either autonomously or in collaboration with indigenous groups. At one
end of the spectrum is, for example, the American Jewish World Service,
which has long-established regional offices and through them implements
health development and emergency programs in needy communities. Likewise,
the Aga Khan Development Network is an Islamic development agency that
operates hospitals and clinics throughout much of East Africa and parts
of Asia. At the other end of the spectrum are organizations such as Corpus
Haiti, a project of a single congregation in up-state New York that runs
an irregular clinic in a small rural village in northern Haiti during the
week-long visits of New York congregants throughout the year. Through the
donations of individuals and institutions in developed countries, foreign
faith-based organizations fund the vast majority of health activities,
technology transfer, and technical assistance that they implement in the
developing world.
25-33% of health funding
spent
in developing countries
is channeled through NGOs,
including many faith-based
organizations
Numbers of Institutions
As a significant proportion of the NGO population, faith-based organizations
fund and provide much of the 40% of health services in developing countries
not provided by national governments. While external funding figures are
difficult to measure, it is estimated that in 1990, between one-quarter
and one-third of health funding spent in developing countries, or approximately
$1 billion, was channeled through NGOs, including many faith-based organizations.
This number has probably risen considerably over the last decade with the
skyrocketing global contributions of assistance to millions of people in
the poorest parts of the world who face natural and civil disasters.
I tried to find statistics of the more concrete (no pun intended) infrastructural
contributions to health development by both governments and NGOs around
the world. However, no organization keeps these data at international or
regional levels – neither the World Council of Churches, the World Bank,
nor even the World Health Organization (which reports to have quit doing
so in the early 1980s). The only data on numbers of hospitals, clinics,
pharmacies, and health training schools are kept at the national level
by ministries of health or statistics – if they are kept at all – or by
NGOs themselves. But we can extrapolate from our own collective experiences
that a significant proportion of hospitals not owned by governments are
operated by faith-based organizations. The distribution of clinics is even
more heavily weighted toward faith-based organizations – one need only
consider Haiti. The sheer number of these health institutions merits –
and often receives – the recognition of national and local governments.
Note that if counting hospitals and clinics is difficult addition, it
is virtually impossible to account for the enormous human resources and
technical expertise constantly provided by faith-based organizations doing
health development internationally.
Quality
Faith-based health institutions in many countries in Africa, Asia, and
Latin America are quality institutions. Because of deeper financial resources
from their ties to the developed world, these institutions are often better
stocked, better equipped, and better managed than government medical institutions.
Drugs and medical equipment can be paid for with hard currencies on the
open world market. Manufacturers in the developed world donate items when
they can be assured of responsible use, which faith-based organizations
are often able to convey. Salaried and wage employees of these organizations
often have a confidence that their next paycheck will be forthcoming, a
luxury that employees of the poorest governments are not consistently afforded.
As a result, faith-based health organizations have access to a broad
qualified employee pool.
Effectiveness
The financial and human resource assistance that faith-based organizations
provide in developing countries is sometimes more effective than government
health assistance. Because they are localized, they are uniquely positioned
to respond directly to the immediate health needs of the people they serve.
The networks that such organizations have because of their religious affiliations
are extensive, adding clientele to their health programs. They are also
able to mobilize communities into productive action and even behavior change.
Such organizations generally summon the trust of the community because
of their qualified staffs, their drug availability, their “modern” technologies,
and their commitment to serving indigent populations. Consequently, the
health services of faith-based organizations are accepted into communities,
used by local residents, and promoted through word-of-mouth. Local government
health activities are not necessarily so effective, as they are often part
of a centralized, country-wide system of services provided in an environment
of severely limited resources.
Faith-based health
organizations
often serve the most needy,
most vulnerable,
and hardest-to-reach populations.
Populations Served
Faith-based health organizations often serve the most needy, most vulnerable,
and hardest-to-reach populations in the developing world. While Ministries
of Health are charged with serving the public’s health, resource constraints
often make equitable distributions of health care services extremely difficult
or even impossible. Thus government health activities may be concentrated
in populated areas and be limited in the types of services provided. Faith-based
organizations are motivated by religious doctrines to address the needs
of the most disadvantaged populations. They often serve those people who
do not have access to health services because of geographic or economic
isolation, social unrest, political crises, or diminishing government funding.
Some developing world governments enter into deliberate partnerships with
faith-based health organizations in order to assure the closest proximity
of universal health coverage possible in the country. SANRU in the former
Zaire is a pre-eminent example.
Health Values Are Religious Values
Many faith-based organizations act out of convictions of equity, justice,
peace, solidarity, and human rights. Increasingly, better health, access
to health care, and social behaviors that contribute to better health are
being seen as intimately linked with these “religious” principles, even
if not advanced in religious contexts. As a result, secular health programs
are adopting these principles as guiding parameters of program implementation.
In summary, faith-based organizations, both indigenous and foreign,
engaged in health activities in the developing world are locally well-established,
effective in health care provision and community mobilization, and guided
by principles widely viewed as essential for meeting the needs of vulnerable
populations. These organizations play an enormous role in health development
around the world as a result of their geographic and socio-economic reach,
their sources of income, and the commitment to their work that stems from
religious convictions. Given these contributions to global health development,
it is puzzling that faith-based health organizations are not often included
in policy discussions at international and national levels and that their
contributions are consistently omitted from reports and statistics on health
in the developing world.
It is puzzling that
contributions of faith-based
health organizations are
consistently omitted
from health reports and
statistics.
Stereotyping
In recent years, the virtual absence of faith-based organizations from
the international dialogue on global health issues has not been mere oversight.
Negative stereotypes have contributed to limited cooperation and information
exchanges. While many such large organizations carry out their health work
with donor government funding and within the health strategies of developing
country governments, thousands of small organizations operate in complete
isolation of national or global health plans. Some of them decline grants
that may require them to compromise their religious beliefs or activities.
Others are ignorant of the possibilities of collaboration. Still others
simply prefer to work independently and avoid association with what they
view as the “inefficient” or “needless” bureaucracies of government.
Secular and government organizations do not consistently seek partnerships
with the faith community.
They are suspicious of the religious motivations of faith-based organizations,
assuming that health development is a secondary goal to spiritual conversion.
They underestimate the experience and caliber of professional staff
working in faith-based hospitals, clinics, and pharmacies.
They deliberately exclude faith-based organizations conducting similar
work because of these concerns or fears.
And they discount these organizations because they believe that they
only provide assistance just to the faithful (an argument for which I have
never heard a supportive case), in contrast to their own non-partial provision
(which could be argued).
While this deficient relationship is not the experience in all developing
countries, it is common at all levels of interaction. This is found to
be true in the health field as well as in other areas of development including
education, agriculture, micro-enterprise, and women’s empowerment.
A growing body of scientific
research
shows linkages between
spirituality
and health and healing.
Recent Trends in Collaboration
Although relations between faith-based and secular organizations working
in health have been less than collaborative, recent trends and events indicate
a potentially different future. A growing body of scientific research shows
linkages between spirituality and health and healing. In fact, in the past
five years, WHO went so far as to revise its definition of “health” to
include a spiritual dimension. The expansion of what comprises “health”
opens doors for the involvement of faith institutions in all areas of health
care provision and promotion.
Legislation and policies around the world are changing and are more
able to easily incorporate faith-based organizations into national health
strategies. For example, as developing country governments move toward
privatization of health services, these organizations and other NGOs must
move in to assume the responsibilities once held by government offices.
Also, there has been the increasing disposition to focus on human rights,
leading to greater global appreciation of the faith community’s activities.
In February 1998, the World Bank convened a meeting with the leaders
of nine main faith traditions. The leaders of the world’s largest funding
institution for developing-world governments and the faith community began
a formal dialogue titled “World Faiths and Development,” a demonstration
that exchange and cooperation are being seen as essential not only for
health but for all areas of development. The Pan-American Health Organization
(PAHO) held its own consultative meeting with leaders of religious institutions
several weeks later where a strong consensus emerged that the time and
conditions are ripe for developing joint activities in health. This sentiment
builds concretely on the words of PAHO’s Director:
Our cautious but firm approach to religious
institutions is another example of our willingness to seek new alliances
and new partners in the increasingly powerful society – always with the
specific aim of furthering the cause of health.
– Sir George Alleyne, 1995
Conclusion
The inclusion of faith-based organizations in service provision, health
care planning, and policy discussions in the developing world must grow
– or we face dire consequences for the health of millions of individuals,
families, and communities.
This article was based on an APHA presentation, Nov. 1999
BIBLIOGRAPHY
Bridging the Gap Between Religious and Secular Health Systems,
CR Ausherman, Executive Director, Institute for Development Training, The
CCIH Forum, Nov 1998.
PAHO Interest in Health and Religious Organizations: A Partnership
for Promotion of Health and a Better Life in the Third Millennium,
JR Teruel, Senior Advisor in International Health, PAHO, The CCIH Forum,
Nov ‘98.
The Role of Christian Health Mission in International Public Health,
C Akukwe, Senior Policy and Planning Advisor, District of Columbia Department
of Health, The CCIH Forum, June 1998.
The Role of Church Groups in Managing Health Districts, FC Baer,
Independent Consultant, The CCIH Forum, Nov 1998.
Public Hospitals in Developing Countries: Resource Use, Cost, Financing.
H Barnum and J Kutzin. Baltimore: Johns Hopkins Univ. Press, 1993.
